All the following conditions are associated with re section of the terminal ileum EXCEPT
|C||low levels of serum iron|
|D||depletion of the bile-sail pool|
a. The bowel has a remarkable capacity to adapt after small bowel resection; in many instances, this process of intestinal adaptation, called adaptive hyperplasia, effectively prevents severe complications resulting from the markedly decreased surface area that is available for absorption and digestion.
b. Although there is considerable individual variation, resection of up to 70% of the small bowel usually can be tolerated if the terminal ileum and ileocecal valve are preserved.
c. Proximal bowel resection is tolerated much better than distal resection because the ileum can adapt and increase its absorptive capacity more efficiently than the jejunum.
d. After massive small bowel resection, the treatment course may be divided into early and late phases.
e. In its early phase, treatment is primarily directed at the control of diarrhea, replacement of fluid and electrolytes, and prompt institution of TPN.
f. Diarrhea in this early phase can be caused by a multitude of sources.
g. For example, hypergastrinemia and gastric hypersecretion occur after massive small bowel resection and greatly contribute to diarrhea after a massive small bowel resection.
h. Acid hypersecretion can be managed by H2-receptor antagonists or proton pump blockers, such as omeprazole.
i. Diarrhea may also be caused by ileal resection, resulting in disruption of the enterohepatic circulation and excessive amounts of bile salts entering the colon.
j. In addition, the judicious use of agents that inhibit gut motility (e.g., codeine and diphenoxylate) may be helpful.
k. The long-acting somatostatin analogue octreotide also appears to reduce the amount of diarrhea during the early phase of short bowel syndrome.